Legislature To Tackle `Mandated Benefits`

TALLAHASSEE — The state steps in to demand that health insurance policies cover regular and thorough medical checkups from birth to age 16 for a child who appears to perfectly healthy.

Unlikely?

Not necessarily. This and other types of so-called ``mandated benefits`` are something the Florida Legislature is expected to consider seriously during its 1986 session.

The House Health Care and Insurance Committee, headed by Rep. Tom Gustafson, D-Fort Lauderdale, is ready to investigate whether the state should impose additional requirements on what insurance companies must offer in the way of health care coverage. Or, on the other hand, should existing mandates be eliminated?

Among the categories of mandated coverage the committee may explore are drug and alcohol abuse treatment, mental and nervous disorder treatment, chiropractic care and even programs to quit smoking.

All the committee is awaiting at this point is a final go-ahead from House Speaker James Harold Thompson, D-Quincy.

And with escalating health care costs on the minds of consumers, employers, insurance companies, government and health care providers, this debate over ``mandated benefits`` promises to be a fierce one.

``Whenever you open up anything concerned with insurance companies . . . everyone will try to get into the act. I think it will rival Barnum and Bailey (circus) by the time it`s over,`` said Rep. John Lewis, D-Jacksonville, head of the subcommittee that will delve into this subject.

Costs usually become the dominant factor in any discussion of the merits of ``mandated benefits.``

Blue Cross and Blue Shield of Florida spokesman Jeff Wollitz explained, ``Generally we are opposed to having benefits mandated because there`s a feeling that mandated benefits add to the cost of health care.``

David Fountain of the Florida Insurance News Service said the industry in general holds that view. ``None of these (mandated benefits) things is evil,`` he said. ``As a concept, it`s not really a bad thing. It`s just expensive, and somebody has to decide whether they`re willing to pay the increased cost.``

Part of the insurance industry`s discomfort with the subject is that it fears mandated benefits only can be forced upon Florida companies -- thus raising their preminiums for health care coverage and making those policies less competitive.

Fountain argued there may a constitutionality problem -- or at the very least an enforcement problem -- if the state imposes mandated benefits on out- of-state health policies as well.

``If everybody had to play by the same rules, yeah, fine, but not everybody does,`` he said.

But Deffenbaugh pointed out another side: ``The best argument (for mandated benefits) is that you`re improving the well-being of the people . . . The Legislature has a responsibility to improve the health of the populace. That`s an unmet social need.``

And advocates say requiring benefits such as ``well-child`` coverage actually would add only $2 to $3 monthly to a health insurance premium -- and in the long run it would save money.

``We have to look at health care not as the treatment of disease. Preventive and wellness (care), that`s what we need more of,`` suggested Rep. Fred Lippman, D-Hollywood. Lippman, a sponsor of the well-child bill that passed the House but died in the Senate this year, said, ``If you take proper care of a child, you will have a healthier adult and a more healthy adult has a less costly total health bill.``

Rep. Bernard Kimmel, R-West Palm Beach, a physician, also promoted the well- child legislation. He said, ``The people who would most benefit . . . would be those in lower-income groups who oftentimes don`t get preventive care. It`s an easy thing to skip. Ideally what we`re looking for from all people is to prevent more acute care later on.``

The trend already leans in the direction of state intervention. Florida, for instance, requires health insurance policies to cover newborns from the moment of birth -- and in 1984 the Legislature passed so-called ``unwed daughter`` coverage that says newborns are included even if they are the grandchildren of the main policyholder.

As for alcohol and drug dependency treatment and mental and nervous disorders, the state so far only mandates these benefits be offered in group health insurance policies (not individual policies). And the main policyholder -- in this case the employer -- makes the choice whether to offer those benefits.